Non-congenital Zika Virus Disease
2024 Case Definition

Clinical Criteria

To meet the clinical criteria for non-congenital Zika virus disease, the person should have one or more of the following not explained by another etiology.

• Acute onset of one or more of the following symptoms: fever (measured or reported), generalized rash, arthralgia, or non-purulent conjunctivitis,
• Guillain-Barré syndrome,
• Loss of a fetus at greater or equal to 20 weeks gestation.

Laboratory Criteria

Confirmatory laboratory evidence: 

• Detection of Zika virus, viral antigen, or viral RNA in a body fluid or tissue; OR
• Detection of anti-Zika virus IgM antibodies in blood or CSF, with positive Zika virus-specific neutralizing antibody titers and negative neutralizing antibody titers against dengue or other flaviviruses endemic to the region where exposure occurred^§

Presumptive laboratory evidence: 

• Detection of anti-Zika virus IgM antibodies in blood or CSF with a negative anti-dengue virus IgM antibody test in the same specimen with no neutralizing antibody testing performed; OR
• Four-fold or greater rise in anti-Zika virus-specific neutralizing antibody titers in paired blood specimens; OR
• In the setting of a Zika virus outbreak^§§ with minimal circulation of other endemic flaviviruses, detection of anti-Zika virus IgM antibodies in blood or CSF.

Note: The categorical labels used here to stratify laboratory evidence are intended to support the standardization of case classifications for public health surveillance. The categorical labels should not be used to interpret the utility or validity of any laboratory test methodology.
^§If Zika and dengue virus IgM antibodies are detected and neutralizing antibodies are unable to differentiate flaviviruses, consider reporting as Flavivirus disease, not otherwise specified (See ArboNET Surveillance Guide).
^§§Consult with CDC as needed for assistance with outbreak status determinations.

Probable

• Meets the epidemiologic linkage criteria, and clinical and presumptive laboratory criteria for non-congenital Zika virus disease.

Confirmed

• Meets the epidemiologic linkage criteria, and clinical and confirmatory laboratory criteria for non-congenital Zika virus disease.

• Zika Virus Disease | 2024 Case Definition
• Zika Virus Disease and Zika Virus Infection | 2016 Case Definition, Approved June 2016
• Zika Virus Disease, Non-congenital Infection and Zika Virus, Congenital Infection | 2016 Interim Case Definition, Approved February 26, 2016